①

①
Academic Year 2014-2015
For Non-Exchange applicants
ONE-YEAR STUDY ABROAD PROGRAM
SCHOOL OF INTERNATIONAL LIBERAL STUDIES, WASEDA UNIVERSITY
to be typewritten
◆Fill in the form using black or blue ink.
◆Write accurately in standard style.
APPLICATION FOR ADMISSION
Period of Study:
Academic Year
(September 21, 2014 - Late July 2015)
Fall Semester (September 21, 2014 - the beginning of February 2015)
Spring Semester (Early April 2015-Late July 2015)
*The schedule is subject to change without any advance notice.
Attach
photographs
(1.2" X 1.6" (3 X 4)
full face, taken against
a plain background) here.
*Print your name
and the date of birth
on the back.
Name: (Indicate your full legal name as it appears in your passport.)
Picture should be taken in 1 month,
1.2" X 1.6" (3cm×4cm) size,
Name in English
/
/
full face, taken against a plain (Family)
(First) background, and(Middle)
please don’t glue
or staple.
Would you like to use your middle name instead of your first name at Waseda?
Yes
Male
Female
No
Name in Katakana
(or write your name in alphabetic characters which show the pronunciation)
E
L
P
M
A
Name in Chinese Characters (Kanji)
(If you are originally from Asian countries, where Kanji is used (China, Korea, Japan and others), please write your
name in Kanji as well.)
Date of birth:
(Month)
(Day)
Home institution:
Current Year in School:
1st
S
(Year)
2nd
Nationality:
3rd
4th
(Country code:
Please put the day when you submit this form.
other (
) as of
(Date)
(Fresh) (Sophomore) (Junior) (Senior)
Cumulative GPA on 4.0 scale:
)
as of the end of previous term /
not applicable
For example, “Faculty of Social Sciences”, etc.
Your school/department:
For example, “Asian Studies”, etc.
Major field:
(Minor field:
Your graduation day to be scheduled:
)
(Month / Year)
If you are planning to receive a scholarship, please put the name of the scholarship and the amount.
If nothing, please put N/A here.
Name of the scholarship:
Amount in yen per month:
yen
Amount in your own currency:
1
Academic Year 2014-2015
Are you currently enrolled in a Japanese language course?
If“yes,”please provide the relevant information below.
Institution
Yes
No
Course title
Credit/Unit to be received
Japanese language proficiency:
Reading:
Excellent
Good
Fair
Poor
None
Writing:
Excellent
Good
Fair
Poor
None
Listening:
Excellent
Good
Fair
Poor
None
Speaking:
Excellent
Good
Fair
Poor
None
Foreign language study other than Japanese (if any):
Language
Period of study
Institution
E
L
P
M
A
Describe any academic honors, awards, or scholarships you have received.
S
Indicate any special support needed in your classes or extracurricular activities, if appropriate.
Family:
Name
Age
Relationship
Occupation
Health:
Rate your general health:
Excellent
Good
Indicate any physical disability or handicap you may have.
2
Fair
Poor
Place of Residence (Country)
①
Academic Year 2014-2015
Present address:
(from
until
Phone:
)
Fax:
E-mail:
If you would like to receive documents from SILS at other address than present address,
please put the address below.
Address to send documents from SILS:
(from
until
Phone:
)
Fax:
E-mail:
If your address is changed after application period, please inform us of your new address.
Special skills and hobbies:
E
L
S
P
M
A
Passport & Visa information:
Passport Number:
Date of issue:
Date of expiration:
Issuing authority:
Do you have any past entry into/stay in Japan?
Yes
time(s)
No
At which Japanese Consulate/Embassy do you plan to apply for a visa?
I certify that all the information provided on this form and in the accompanying documents is complete and accurate to
the best of my knowledge, and, if admitted, I agree to comply with the rules and regulations of Waseda University.
Date:
Signature:
(Month)
(Day)
(Year)
3
Academic Year 2014-2015
Explain your academic objectives (beyond language or cultural acquisition) and academic fields in which you
wish to accomplish them at the One-Year Study Abroad Program at the School of International Liberal Studies.
* Semester-long applicants are also required to explain why they cannot stay for a full academic year.
*Please TYPE at least a 2- page essay.
If you cannot type on this page
directly, please write at least 2-page
long essay in A4 size, and attach it to
the application documents.
E
L
S
4
P
M
A
①
Academic Year 2014-2015
E
L
S
P
M
A
5
Academic Year 2014-2015
E
L
S
P
M
A
This is the end of the sample. Please fill in the form from the next page.
6
①
Academic Year 2014-2015
For Non-Exchange applicants
ONE-YEAR STUDY ABROAD PROGRAM
SCHOOL OF INTERNATIONAL LIBERAL STUDIES, WASEDA UNIVERSITY
to be typewritten
◆Fill in the form using black or blue ink.
◆Write accurately in standard style.
APPLICATION FOR ADMISSION
Period of Study:
Academic Year
(September 21, 2014 - Late July 2015)
Fall Semester (September 21, 2014 - the beginning of February 2015)
Spring Semester (Early April 2015-Late July 2015)
*The schedule is subject to change without any advance notice.
Attach
photographs
(1.2" X 1.6" (3 X 4)
taken in 3 months,
full face) here.
*Print your name
and the date of birth
on the back
Name: (Indicate your full legal name as it appears in your passport.)
Name in English
/
Male
Female
/
(Family)
(First)
(Middle)
Would you like to use your middle name instead of your first name at Waseda?
Yes
No
Name in Katakana
(or write your name in alphabetic characters which show the pronunciation)
Name in Chinese Characters (Kanji)
(If you are originally from Asian countries, where Kanji is used (China, Korea, Japan and others), please write your
name in Kanji as well.)
Date of birth:
Nationality:
(Month)
(Day)
(Country code:
)
(Year)
Home institution:
Current Year in School:
1st
2nd
3rd
4th
other (
) as of
(Date)
(Fresh) (Sophomore) (Junior) (Senior)
Cumulative GPA on 4.0 scale:
as of the end of previous term /
not applicable
Your school/department:
Major field:
(Minor field:
Your graduation day to be scheduled:
)
(Month / Year)
If you are planning to receive a scholarship, please put the name of the scholarship and the amount.
Name of the scholarship:
Amount in yen per month:
yen
Amount in your own currency:
1
Academic Year 2014-2015
Are you currently enrolled in a Japanese language course?
If“yes,”please provide the relevant information below.
Institution
Yes
No
Course title
Credit/Unit to be received
Japanese language proficiency:
Reading:
Excellent
Good
Fair
Poor
None
Writing:
Excellent
Good
Fair
Poor
None
Listening:
Excellent
Good
Fair
Poor
None
Speaking:
Excellent
Good
Fair
Poor
None
Foreign language study other than Japanese (if any):
Language
Period of study
Institution
Describe any academic honors, awards, or scholarships you have received.
Indicate any special support needed in your classes or extracurricular activities, if appropriate.
Family:
Name
Age
Relationship
Occupation
Health:
Rate your general health:
Excellent
Good
Indicate any physical disability or handicap you may have.
2
Fair
Poor
Place of Residence (Country)
①
Academic Year 2014-2015
Present address:
(from
until
Phone:
)
Fax:
E-mail:
If you would like to receive documents from SILS at other address than present address,
please put the address below.
Address to send documents from SILS:
(from
until
Phone:
)
Fax:
E-mail:
If your address is changed after application period, please inform us of your new address.
Special skills and hobbies:
Passport & Visa information:
Passport Number:
Date of issue:
Date of expiration:
Issuing authority:
Do you have any past entry into/stay in Japan?
Yes
time(s)
No
At which Japanese Consulate/Embassy do you plan to apply for a visa?
I certify that all the information provided on this form and in the accompanying documents is complete and accurate to
the best of my knowledge, and, if admitted, I agree to comply with the rules and regulations of Waseda University.
Date:
Signature:
(Month)
(Day)
(Year)
3
Academic Year 2014-2015
Explain your academic objectives (beyond language or cultural acquisition) and academic fields in which you
wish to accomplish them at the One-Year Study Abroad Program at the School of International Liberal Studies.
* Semester-long applicants are also required to explain why they cannot stay for a full academic year.
*Please TYPE at least a 2- page essay.
4
①
Academic Year 2014-2015
5
Academic Year 2014-2015
6